Monday, August 10, 2015

Failed IVF implantation – The Best Way to Brace Yourself

A failed IVF cycle causes a lot of anguish, both for the patient as well as the doctor. It's extremely frustrating when the cycle fails, and the first question the patient asks is – “Dr, why did the cycle fail?” Doctors are under a lot of pressure to answer this question, which is why they order a slew of tests to try to pinpoint why the embryos did not implant.

Sadly, the truth is that our tests are of very limited use in this setting. We do know that the commonest reason embryos do not implant is because they have genetic defects within them, which cause them to arrest. This is essentially nature's defense mechanism, to prevent the birth of an abnormal baby. However, the current-day genetic tests available are quite crude. Thus, tests such as PGS/CCS/NGS only allow us to count the number of chromosomes - we can’t really analyze defects at the gene level yet.

The harmful impact of over-testing

The big danger is that testing is not benign. Doing unnecessary tests only ends up harming the patients and many of these tests produces false positives. Thus, doctors will do a test for TB PCR, and then "treat" completely normal patients with 9 months of toxic drugs. Others will check for "NK cell activity" and treat patients with expensive IV immunoglobulins, of unproven efficacy.

Our first sacred oath as physicians is to “do no harm,” and ideally, such therapies should be approached with skepticism. A "pseudodiagnosis" can end up being an expensive exercise for the patient- in terms of time and money!

A piece of advice

I have simple piece of advice for patients who’ve had a failed an IVF cycle & have had a workup done by an IVF specialist with no clear answers . " Please accept the fact that IVF specialists may not always be able to provide you with answers. Instead of responding with despair, please rejoice that everything is normal. Count your blessings that there are no problems; and understand that even though our technology is not very good for identifying problems, IVF is great for providing solutions by bypassing them. And just because 1-2 IVF cycles have failed does not mean that the next one will as well - all you need is patience, motivation and resilience. The rewards are well worth it!”

It’s important to bounce back and empower yourself, instead of just hoping that if you find the “right doctor’, the “right answer” will come to you. Above all, it’s important for patients to realize that it’s better to have no answer rather than a wrong one.